Central Nervous System Radiation Oncology

The Brain Stereotactic Radiosurgery (SRS) Program offers precision treatment for MD Anderson patients with malignant and benign intracranial disease. Treatment is offered at MD Anderson’s Texas Medical Center campus and its locations across the Houston area.

The program closely coordinates and integrates clinical expertise, multidisciplinary care pathways, advanced treatment planning and radiosurgical technology to ensure consistent, high-quality care throughout the institution.

The Brain SRS program enhances access to advanced radiosurgical care, strengthens multidisciplinary collaboration, supports research and clinical innovation, and reinforces MD Anderson’s role as a leader in intracranial radiosurgery and treatment of CNS tumors.

Program scope & clinical focus

The Brain SRS Program provides comprehensive radiosurgical management for:

• Malignant brain tumors including brain metastases and selective primary central nervous system (CNS) tumors
• Benign tumors including pituitary adenoma, meningioma and acoustic neuroma
• Non-neoplastic intracranial conditions such as trigeminal neuralgia and arteriovenous malformation (AVM)
• Select functional conditions such as obsessive-compulsive disorders (OCDs)

Treatment modalities

The program utilizes the following treatment modalities:

• Gamma Knife Radiosurgery
• LINAC-based Stereotactic Radiosurgery

Treatment decision-making, planning and delivery

The Brain SRS Program has a robust treatment planning and delivery process, including:

• A dedicated weekly multidisciplinary tumor board, attended by radiation oncology, neuroradiology and neurosurgery. The board reviews all patients being considered for brain SRS treatment.
• Gamma Plan, Brainlab Elements and RayStation treatment planning are used for high-precision dose sculpting.
• High-quality and standardized contouring and planning, along with state-of-the-art imaging and delivery protocols, are utilized across all MD Anderson locations.
• The program’s rigorous and highly efficient radiation plan quality assurance process involves radiation oncologists and radiation physicists before delivery of radiation.

Integration with institutional clinical pathways

The Brain SRS Program partners with the multidisciplinary teams involved in the management of intracranial tumors and conditions, including neurosurgery, neuro-oncology, medical oncology, neuro-radiology and neuropathology. It also works closely with the Brain Metastasis Clinic and Research Program to promote research and support optimal patient care, such as coordinated triage, referral pathways, treatment logistics and shared clinical decision-making across service lines.

Clinical credentialing and training standards

Clinicians participating in the Brain SRS Program complete a structured credentialing pathway, including formal Gamma Knife training, supervised case participation, verification of planning competency and ongoing maintenance of privileges through periodic case review and continuing education.

Research and innovation

The program provides support for investigator-initiated and industry-sponsored trials. It currently is collaborating in research focused on radiobiology, immunotherapy–SRS interactions and imaging analytics.

Program members also conduct multiple brain SRS clinical trials, including several initiated and led by CNS radiation oncologists. These include:

• Preoperative vs. Postoperative SRS Trial – PI: Dr. Nana Yeboa, M.D.
• EXCLAIM Trial evaluating the optimal timing of SRS in patients receiving CNS-penetrating systemic therapy – PI: Thomas Beckham, M.D., Ph.D.
• SRS Hypophysectomy Trial investigating the safety and efficacy of SRS hypophysectomy for intractable cancer-related pain – PI: Chenyang Wang, M.D., Ph.D.
• Post-SRS Re-irradiation Trial evaluating re-irradiation after SRS failure – PI: Subha Perni, M.D.

Education and training

Members of the brain SRS program give regular talks to MD Anderson trainees. Program faculty also organize multidisciplinary lectures on brain SRS to MD Anderson Cancer Network physicians.

Program milestones

• First Gamma Knife patient treated in June 2009; 5,000th patient treated in March 2019. We expect to reach 10,000 patients by the end of fiscal year 2026.
• A second Gamma Knife unit was added in 2018, enabling mask-based treatments. The state-of-the-art program has evolved from one Perfexion system, to two ICON units, and now to one ICON and one ESPRIT machine.
• Brainlab Elements planning was introduced in 2024 to align treatment at all MD Anderson locations. This has led to the doubling of LINAC-based SRS cases treated with this modality in less than two years.

Program leadership

• Director: Jing Li, M.D., Ph.D., Chair-ad-interim Central Nervous System Radiation Oncology
• Co-Director: Tina Briere, Ph.D., Section Chief for Central Nervous System Radiation Physics

The Spine Stereotactic Body Radiotherapy (SBRT) Program is one of the world’s most experienced and innovative dedicated to precision radiation treatment for spinal metastases and primary spinal tumors.

For more than two decades, the MD Anderson Spine SBRT Program has defined the global standard for precision radiotherapy in spinal tumors. Through research, technology and multidisciplinary collaboration, our team continues to deliver safer, more effective and more personalized treatments that improve outcomes and quality of life for patients around the world.

To date, MD Anderson has treated more than 4,000 patients with spine SBRT, making it one of the largest such groups in the world. The program achieves local control rates of more than 90% and durable outcomes even in radioresistant disease.

Program highlights

• More than 4,000 patients treated since program inception
• Greater than 90% two-year local control across histologies
• Pioneers in SBRT for metastatic epidural spinal cord compression and currently enrolling in a prospective phase II trial evaluating SBRT without surgery
• Multidisciplinary Spine Metastases Clinic and weekly Spine Tumor Board for comprehensive and coordinated evaluation
• Advanced SBRT delivery enabling safe re-irradiation and treatment in complex postoperative settings

Research and clinical trials

MD Anderson investigators have authored approximately 100 peer-reviewed publications over the past decade on spine tumor management, establishing one of the most robust evidence-bases worldwide for spine SBRT.

Foundational work by program faculty defined early efficacy and safety standards, and subsequent studies refined optimal dose, fractionation and spinal cord constraints that are now adopted globally. The team continues to lead prospective and randomized clinical trials defining the next generation of spine SBRT practice.

Current trials

• Phase II MR LINAC Spine SBRT Trial: MRI-guided adaptive SBRT. NCT05709782. PI Debra Yeboa, M.D.
• Single vs. Multifraction Salvage Spine SBRT: Randomized phase II trial. NCT03028337. PI Amol Ghia, M.D.
• CT-on-Rails or Trilogy SBRT: Early prospective technology evaluation. NCT01434659.
  
• SBRT for Spinal Metastases: Foundational institutional trial. NCT00508443. 
• Thermal Ablation + SBRT: Combination interventional radiology and SBRT study. NCT02340942.
• MRI Simulation for SBRT: MRI-based planning optimization. NCT02526431.
• Cord Dose Escalated SBRT (CDE-SSRS): Phase II cord-sparing escalation trial. NCT03220617.

Complementary translational studies explore ctDNA, immune modulation and radiobiologic mechanisms following high-dose spine SBRT.

Innovation and technology

The program employs state-of-the-art image guidance, adaptive planning, and precision delivery to achieve sub-millimeter targeting accuracy while minimizing radiation dose to the spinal cord and surrounding organs.

These methods enable safe and effective treatment even in re-irradiation and complex postoperative settings.

Education and training

Radiation oncology residents and fellows gain advanced experience through the Spine SBRT Program, participating in:

• Formal educational lectures on spine radiosurgery techniques and outcomes
• Twice-weekly prospective multidisciplinary contour and planning directive review sessions
• Tumor boards and clinical research participation to reinforce translational understanding and precision planning

Program faculty

The spine SBRT teams collaborate through joint clinics, twice-weekly tumor board reviews and integrated treatment planning to ensure individualized, evidence-based care for each patient.

Radiation Oncology

• Amol J. Ghia, M.D., Director
• Martin Tom, M.D., Associate Director
• Jing Li, M.D., Ph.D.
• Thomas Beckham, M.D., Ph.D.
• Debra Yeboa, M.D.
• Mary Fran McAleer, M.D., Ph.D.
• Chenyang Wang, M.D., Ph.D.
• Subha Perni, M.D.
• Todd Swanson, M.D., Ph.D.
• Brian De, M.D.
• Jay Reddy, M.D.
• Julianna Bronk, M.D.

Spine Neurosurgery

• Larry Rhines, M.D., Director, Spine Tumor Program (Neurosurgery)
• Claudio Tatsui, M.D
• Rob North, M.D.
• Christopher Alvarez-Breckenridge, M.D., Ph.D.
• Gil Kimchi, M.D.

Interventional Radiology

• Rahul Sheth, M.D.

Diagnostic Imaging

• Behrang Amini, M.D., Ph.D.